Our impact on health disparities
Protecting babies before pregnancy
Premature infants face increased risks for serious health problems, such as developmental disabilities, learning and behavioral problems, cerebral palsy, lung problems, and vision and hearing loss, according to the March of Dimes. African American women have a 70% higher risk of having a preterm birth than other women in the United States. Vijaya K. Hogan, DrPH, clinical associate professor of maternal and child health, is working to eliminate this – and other maternal and infant health disparities.
Hogan and colleagues want to identify the underlying social factors that may affect a woman’s health status and her participation in health care before her baby is even conceived. Health status before pregnancy is thought to have a huge impact on pregnancy outcomes and to be a large determinant of disparities. They are using data collected from women who participated in the largest study in the United States to date that tested how health care interventions before pregnancy – called interconceptional health care – may reduce women’s risk of preterm birth. So far, Hogan is finding that even when other known barriers to care (childcare, transportation etc.) are addressed, several other factors affect women’s ability to access and participate in interconceptional health care. Multiple burdens, racism, lack of social power, unpredictable social emergencies, and institutional rules that eliminate the flexibility women require to adapt to emergent social challenges, are just some of these factors. Defining these social factors and finding a way to reduce them will improve preventive care and help reduce the risk of preterm birth among this group of women.
It has been estimated that more than 2 million U.S. children are victims of childhood maltreatment each year, which can have serious lifelong effects on health. Research assistant professor in maternal and child health, Jon Hussey, PhD, studies health consequences of childhood maltreatment. Using data of more than 15,000 people being followed from adolescence into adulthood in the National Longitudinal Study of Adolescent Health, Hussey and his team examined four types of maltreatment: supervision neglect, physical neglect, physical assault and contact sexual abuse. Remarkably, Hussey’s findings indicate that physically assaulted and (particularly) neglected children are more likely to drink, smoke, use marijuana and report poor health than peers not experiencing child maltreatment. This is the first nationally representative longitudinal study to link childhood maltreatment to poor health and use of unhealthy substances later in life. As health indicators in adolescence and early adulthood are predictive of future chronic disease risk, Hussey is now extending his work to include looking at other significant childhood factors that could affect long-term health and plans to increase the length of time he follows people into adulthood. The major objective of the next phase is to explore the pathways linking early life exposures to racial disparities seen in chronic disease risk. It is this work that will likely yield significant policy and practice implications.
Breastfeeding: best feeding for babies
In North Carolina, African American women are 30 percent less likely to breastfeed their infants, even though studies have shown that breastfeeding helps protect infants from many types of health problems. Tamar Ringel-Kulka, MD, research assistant professor of maternal and child health, is working to change that dynamic. Through community-based participatory research, she leads an effort to promote breastfeeding among African American women in Durham, N.C.
With the Community Health Coalition in Durham and other community organizations, businesses and individuals, Ringel-Kulka has developed the Durham Breastfeeding, Education and Support Team (BEST) Alliance, a group aimed at increasing the rates of breastfeeding among African American women who are pregnant or who have newborns.
The first step was to complete a comprehensive community needs assessment examining breastfeeding. The assessment consisted of reviewing data from focus groups with African American mothers, fathers and grandmothers, and conducting interviews with community stakeholders. Ringel-Kulka’s assessment provided detailed information about the disparity in breastfeeding in the Durham community, identified barriers that limit breastfeeding, and identified potential strategies that may effectively increase breastfeeding. The findings are being used to develop, implement and evaluate a pilot breastfeeding promotion intervention tailored to the needs of the Durham community.
Behavioral health benefits for families engaged in the child welfare system
How can child welfare agencies in the U.S. connect children and their parents with behavioral health services they need? What resources do they need to facilitate these connections? Those questions interest Rebecca Wells, PhD, associate professor of health policy and management at UNC Gillings School of Global Public Health. Using data from a national survey of families engaged with the child welfare system, Wells and her colleagues analyze agency practices that may affect children’s access to mental health services. Among Wells’ initial findings: Caseworkers devote comparable effort to obtaining a range of health services for black and white children once they have identified need, but are less likely to report black children as needing mental health services; Youth engaged with child welfare agencies are more likely to receive substance abuse treatment when their caseworkers had better cooperation with schools, courts, and other agencies; and When caseworkers had social work degrees, parents were more likely to report receiving family counseling as well as mental health treatment for themselves. Partnering with child welfare agencies, Wells works to close gaps and improve access to behavioral health care for families in the child welfare system.